Myocardial Energetics in Hypertensive Cardiovascular Health
Summary
Hypertension imposes a sustained pressure overload on the left ventricle, driving a cascade of structural and metabolic adaptations that reshape myocardial energy handling. In the healthy heart, adenosine triphosphate (ATP) generated by mitochondrial oxidative phosphorylation fuels contractile work and maintains ion homeostasis. Chronic elevation of afterload promotes concentric left ventricular hypertrophy, alters substrate preference towards fatty acid oxidation and impairs the efficiency of ATP synthesis and utilisation. These shifts increase myocardial oxygen consumption for a given workload, diminish the conversion of chemical energy into mechanical output and predispose to diastolic dysfunction, subclinical systolic impairment and ultimately heart failure with preserved ejection fraction. Insulin resistance, microvascular rarefaction and low-grade inflammation compound energetic inefficiency, accelerating adverse remodelling and heightening cardiovascular risk. Non-invasive measures of mechano-energetic efficiency offer new tools to quantify energetic compromise, refine risk stratification in hypertensive populations and guide metabolic or haemodynamic interventions aimed at restoring energetic balance.
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Myocardial Energetics in Hypertensive Cardiovascular Health publication trend
The graph below shows the total number of articles in myocardial energetics in hypertensive cardiovascular health across all publications each year (not limited to Nature Index journals).
Technical terms
Adenosine triphosphate (ATP): The primary chemical currency of cellular energy, produced by mitochondria and used for contractile work and ion transport in cardiomyocytes.
Mechano-energetic efficiency (MEE): The ratio of external mechanical work performed by the left ventricle to the chemical energy consumed, reflecting overall conversion efficiency.
Indexed mechano-energetic efficiency (MEEi): MEE normalised to left ventricular mass, providing a measure of energy performance per gram of myocardium.
Left ventricular hypertrophy (LVH): Thickening of the ventricular wall in response to chronic pressure overload, often accompanied by fibrotic remodelling and energetic inefficiency.
Oxidative phosphorylation: The mitochondrial process by which electrons from nutrient substrates drive ATP synthesis via the electron transport chain, central to myocardial bioenergetics.
References
- Determinants of improvement of left ventricular mechano-energetic efficiency in hypertensive patients. Frontiers in Cardiovascular Medicine (2022).
- From Structural to Functional Hypertension Mediated Target Organ Damage—A Long Way to Heart Failure with Preserved Ejection Fraction. Journal of Clinical Medicine (2022).
- Depressed Myocardial Energetic Efficiency Increases Risk of Incident Heart Failure: The Strong Heart Study. Journal of Clinical Medicine (2019).
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